Official Arkansas Name Change Request Template in PDF

Detailed Instructions for Using Arkansas Name Change Request

Once you've decided to change your name in Arkansas, especially if you're a nurse or hold another licensure governed by the Arkansas State Board of Nursing (ASBN), it's crucial to update your professional records to reflect this change. The Arkansas Name Change Request Form is designed to make this update as straightforward as possible. Filling out this form correctly ensures that your nursing documentation matches your legal name, which is necessary for maintaining the integrity of your license and compliance with state regulations. Follow these steps to complete the form accurately.

1. At the top of the form, skip the "FOR OFFICE USE ONLY" section, as it is intended for internal use by ASBN staff.
2. Under the "NAME CHANGE REQUEST" section, write your previous name in the "FIRST MIDDLE MAIDEN LAST" format.
3. Next, fill in your new name in the "FIRST MIDDLE LAST" format.
4. Select the reason for your name change by checking the appropriate box: Marriage, Divorce, Religious Order, or Other. If "Other" is selected, be specific about the reason.
5. Enter the county and state where your name change was legally recorded.
6. Provide your Social Security Number in the designated space.
7. Fill in your telephone number(s), marking one as "HOME" and, if applicable, the other as "WORK."
8. Include your License Number in the space provided.
9. Write your current address, including STREET/P.O. BOX, CITY, STATE, and ZIP.
10. Provide your email address for communications regarding this request.
11. Enter your Date of Birth and the Date of Legal Name Change, using the MM/DD/YYYY format for both.
12. Under "Name Change for:", indicate the type(s) of license you hold (RN, LPN, LPTN, APRN, RNP) by checking the appropriate box(es).
13. Attach a copy of the marriage license, divorce decree, or court action that documents your name change. Ensure both the front and back are included.
14. In the "Declaration of primary state of residence" section, declare your primary state of residence by writing the state's name. This declaration is necessary under the Nurse Licensure Compact.
15. Sign and date the form at the bottom to affirm the information provided.
16. If you are requesting a replacement license, fill in the "Replacement License Fee" section by selecting your method of payment (In-state personal check, Money order/cashiers check, or Credit with the card type, cardholder’s name and address, credit card number, expiration date, and amount paid. Remember to add the $30.00 fee per license and the $0.90 processing fee for credit card payments.
17. Sign under the "CREDIT CARD INFORMATION" section if you're paying with a credit card.

After completing and reviewing the form to ensure all information is accurate and complete, submit it along with any required documentation and fees to the ASBN. It's important to retain a copy of all submitted materials for your records. The processing of your name change request helps ensure that your professional identity and licenses remain in good standing, reflecting your current legal name. It's one of the critical steps in maintaining the integrity of your licensure after a name change.

What documents are required to request a name change with the Arkansas State Board of Nursing?

When requesting a name change, applicants must provide a copy of the legal document that officially acknowledges the name change. This document could be a marriage license, divorce decree, or court action that shows the new name clearly. It's important to attach both the front and back of the document to the request form.

Is there a fee associated with changing my name on my nursing license in Arkansas?

There is no fee for filing a name change request alone; however, if you wish to receive a replacement license showing your new name, a charge of $30.00 per license applies. Remember, this fee is nonrefundable, and there's an additional nominal processing fee if you choose to pay with a credit card.

How do I declare my primary state of residence when requesting a name change?

In the section provided on the name change request form, you'll need to declare your primary state of residence. This is in compliance with the Nurse Licensure Compact, and your declared state should be your permanent and principal home for legal purposes. Accurate declaration is crucial for proper processing of your request.

What types of payment are accepted for the replacement license fee?

For those opting to receive a replacement license, the Arkansas State Board of Nursing accepts several methods of payment including in-state personal checks, money orders, cashier’s checks, and credit cards (Visa, MasterCard, Discover). Note that credit card payments include an additional processing fee, which was $0.90 at the time of writing.

How should I sign my nursing documentation after submitting a name change request?

Until the name change has been officially processed and acknowledged by the Arkansas State Board of Nursing (ASBN), you must continue to sign all nursing documentation with the name that is currently on file with the ASBN. Once your name change is official, you should start signing with your new name, as that will be the name on file.

What is the correct address to send my name change request form to the Arkansas State Board of Nursing?

The completed name change request form, alongside the required documentation and any applicable fees, should be sent to the following address for processing: Arkansas State Board of Nursing, University Tower Building, 1123 South University, Suite 800, Little Rock, Arkansas, 72204. It's advisable to ensure all parts of the form are completed and the correct documents are attached to avoid delays in the processing of your request.

1. Not providing complete legal name changes in the designated spaces. Many applicants neglect to fill out all parts of the section requiring the change from their first, middle, maiden, and last name to their new legal name, which can delay the process. They often forget to include their middle name or maiden name, assuming that only their first and last names are required. This oversight often leads to the necessity of submitting additional documentation or corrections.

2. Forgetting to include the relevant legal document. The form requires an attachment of a legal document (e.g., marriage license, divorce decree, or court action) that officially recognizes the name change. Sometimes, applicants only submit the form without attaching a copy of the required legal document, leading to processing delays or even rejection of the request. It’s crucial that both front and back copies of the document are provided, as each side may contain critical information for verifying the name change.

3. Incorrectly filling out the payment section. Some applicants either choose the wrong method of payment or fill out the credit card information incorrectly. Issues often include writing an in-state check when the applicant resides out of state, providing an expired credit card, or missing the signature that authorizes the payment. It is important to ensure that all payment details are correct and complete to avoid any delays.

4. Failing to declare a primary state of residence. The form asks the applicant to declare their primary state of residence, a requirement under the Nurse Licensure Compact. Sometimes, this declaration is overlooked or misunderstood. Applicants may not realize the importance of this section, especially how it pertains to their legal residency and implications for where they are allowed to practice nursing.

5. Omitting contact information or providing outdated details. Applicants often forget to include their current address, email address, or phone numbers. When contact information is missing or outdated, it significantly hinders the Board’s ability to communicate with the applicant regarding the status of their request or to inform them of any issues that need to be resolved.

6. Misunderstanding the ‘Name Change Request - No Fee’ option. This choice implies that there’s no fee for the name change to be filed with the ASBN, but it does not exempt applicants who want a replacement license reflecting their new name from the $30.00 fee per license. Some applicants select this option thinking it covers the replacement license as well, leading to incomplete submissions when the required fee is not included.

• Attention to detail is essential: A common theme across these mistakes is the lack of attention to detail. Taking the time to carefully review and complete every section of the form can prevent unnecessary delays.
• Double-check submissions: Before sending the form, applicants should double-check their submission for completeness and accuracy, including the attachment of required documents and the proper completion of payment information.
• Seek clarification when needed: If any part of the form is unclear, reaching out to the Arkansas State Board of Nursing for clarification can help avoid mistakes. It’s better to ask questions before submitting than to resolve issues after the fact.

When you're navigating the process of legally changing your name in Arkansas, especially as a nurse or nursing professional, filling out the Arkansas Name Change Request form is just the beginning. This initial step is crucial for ensuring your professional records accurately reflect your new identity. However, to successfully complete the name change process, additional documents are commonly required. These documents not only support your request but also ensure that everything is legally and officially in order.

• Marriage License: For those who have changed their names due to marriage, a certified copy of the marriage license is essential. This document serves as a legal proof of the name change due to the matrimonial union and is often required to update professional licenses, bank accounts, and other official records.
• Divorce Decree: If the name change is a result of a divorce, a certified copy of the divorce decree specifying the return to a maiden name or a new name altogether is necessary. This legal document is crucial for verifying the name change and updating records accordingly.
• Court Order: For name changes not related to marriage or divorce, a certified copy of the court order granting the name change is required. This document is the result of a legal process wherein a court has authorized the change of name, establishing the new name as the individual's legally recognized name.
• Declaration of Primary State of Residence: Although not a form, declaring your primary state of residence is crucial for nurses who hold or intend to acquire a multi-state license under the Nurse Licensure Compact. This declaration ensures compliance with state-specific licensing requirements and helps maintain the validity of your professional credentials across state lines.

The journey of changing your name, especially within a profession that requires licensure, entails navigating through various legal requirements and ensuring that every piece of your professional and personal identity aligns with your new name. For professionals, such as nurses, ensuring that all supplementary documents like marriage licenses, divorce decrees, or court orders accompany your Arkansas Name Change Request form is essential for a smooth transition. Attention to detail and thorough preparation make all the difference in legally solidifying a new chapter in one's personal and professional life.

The Arkansas Name Change Request form is similar to the Passport Name Change Application in that both involve a formal process of updating one's name due to personal reasons such as marriage, divorce, or a court-ordered name change. In both cases, the applicant must provide legal documentation proving the name change, and there is typically a fee associated with processing the request. These documents are vital for ensuring that personal identification remains current and legally recognized.

Similar to Voter Registration Update forms, the Arkansas Name Name Change Request requires individuals to update their personal details following a name change to ensure their eligibility to vote under their new name. Both forms necessitate the submission of legal documentation as evidence of the name change and include personal information such as the current address, telephone number, and signature for verification purposes. Keeping voter registration information current is essential for participating in elections without complications.

The Social Security Name Change form shares similarities with the Arkansas Name Change Request, as both are necessary for updating one's name in official government records. When undergoing a name change, it's crucial to inform the Social Security Administration to ensure that earnings and social security benefits are accurately recorded. Likewise, nurses must update their name with the Arkansas State Board of Nursing to maintain the validity of their license. Each form requires proof of the name change through legal documents.

Professional License Update forms in various fields bear resemblance to the Arkansas Name Change Request form. Regardless of profession, when individuals undergo a name change, they must update their professional license to reflect their current legal name. This ensures that their credentials remain in good standing and consistent across professional and governmental records. Both require adequate proof of name change, such as a marriage license or court decree, to process the update.

The Arkansas Name Change Request form is similar to the Driver’s License Name Change form. After a legal name change, individuals are required to update their driver's license to reflect their new name, much like how nurses must update their information with the Arkansas State Board of Nursing. Both processes demand the submission of legal documentation to confirm the name change and ensure that state records are accurate and up to date.

Lastly, the Bank Account Name Change form is another document similar to the Arkansas Name Change Request. Following a legal name change, individuals must update their name with their bank to ensure that their financial records are correct and to prevent any issues with transactions. Similarly, nurses need to update their name with the Nursing Board to ensure that their licensure remains valid. Both forms necessitate the provision of legal proof of the name change and personal identification details.

When completing the Arkansas Name Change Request form, certain steps should be strictly followed to ensure accuracy and compliance with the Arkansas State Board of Nursing (ASBN) requirements. Here are some do's and don'ts that can serve as a guide through this process.

Do:

1. Ensure that the name change is legally recognized before submitting the form. Legal documents such as a marriage license, divorce decree, or court action must be included to verify the change.
2. Complete every section of the form accurately. This includes the personal information section, the declaration of the primary state of residence, and the method of payment for those requesting a replacement license.
3. Attach a copy (front and back) of the legal document that officially recognizes your name change. This is essential for verification purposes.
4. Sign the form with the name currently on file with ASBN until the name change process is officially completed.
5. Use a current address and contact information to ensure you receive any correspondence regarding your name change request.

Don't:

1. Falsify information on the form. Doing so can lead to disciplinary action against your license.
2. Forget to declare your primary state of residence if your licensing is part of the Nurse Licensure Compact. This information is crucial for maintaining the validity of your license across state lines.
3. Omit any of the required fees associated with your name change request, especially if requesting a replacement license. Remember, fees are nonrefundable.
4. Submit incomplete documentation. The absence of the required legal documentation verifying your name change can delay or invalidate your request.
5. Overlook the processing fee associated with paying the replacement license fee by credit card. Though nominal, it is an additional cost not covered by the license fee itself.

There are several misconceptions about the Arkansas Name Change Request form process for nurses, which may confuse or mislead individuals looking to update their name with the Arkansas State Board of Nursing (ASBN). By clarifying these misunderstandings, individuals can approach the name change process with a clearer understanding.

• Misconception 1: You have to pay a fee for a name change regardless of your circumstances.

Many individuals mistakenly believe that a fee is always required when requesting a name change on their nursing license. However, the form specifies a "NAME CHANGE REQUEST - NO FEE" option. This means that simply updating your name on file with the ASBN does not incur a fee. A fee is only required if you are requesting a replacement license to reflect your new name.

• Misconception 2: A replacement license is automatically issued when you change your name.

Contrary to this belief, the form clearly states that "You will not receive a replacement license, but your name change will be on file with ASBN" unless you specifically request and pay for a replacement license. This indicates that an additional step is necessary for those who wish to receive a new license displaying their new name.

• Misconception 3: Any document related to a name change is acceptable for the process.

While the form requires documentation for a name change, it specifically lists acceptable documents such as a marriage license, a divorce decree, or court action showing the newly changed name. This specification dispels the myth that any document indicating a name change is suitable for this process. Not all documents related to a name change are considered sufficient for the requirements set forth by the ASBN.

• Misconception 4: The process does not accommodate for changes other than marriage or divorce.

There is a common misconception that the form only allows for name changes due to marriage or divorce. However, the form also includes "Religious Order" and "Other" options, accommodating a wider range of circumstances that may lead to a legal name change. This shows an understanding that there are numerous reasons why someone might change their name, beyond the commonly assumed reasons of marriage or divorce.

Filling out the Arkansas Name Change Request form is essential for nurses who have undergone a legal name change. Getting every detail right ensures that your professional records reflect your current legal name, important for both your career and legal compliance. Here are some key points to consider:

• Form Purpose: This form is specifically for individuals licensed by the Arkansas State Board of Nursing (ASBN) who need to update their name on official records.
• No Fee for Name Update: If you're only updating your name on file without requesting a replacement license, there's no fee. This makes the process more accessible for everyone.
• Replacement License Cost: If you choose to obtain a replacement license that reflects your new name, there is a $30 fee for each license you're updating.
• Legal Documentation Required: You must attach a copy (both front and back) of the legal document that confirms your name change, such as a marriage license, divorce decree, or court action document.
• Signing Documents: Remember to sign any nursing documentation with the name currently on file with the ASBN until your name change has been officially processed.
• Payment Methods: The ASBN accepts in-state personal checks, money orders, cashier's checks, and credit cards. Note that there's a nominal fee for processing credit card payments.
• Nurse Licensure Compact Compliance: If you're part of the Nurse Licensure Compact, you'll declare your primary state of residence, which is relevant for determining your eligibility for a multi-state license.
• Accuracy is Key: Ensure all information, from your social security number to your license number and current contact information, is accurate to avoid processing delays.
• Falsification Warning: The form warns that falsifying information can lead to disciplinary action against your license, underscoring the importance of honesty throughout the process.

By carefully following these guidelines, nurses can ensure a smooth transition to their new legal name across professional records, maintaining compliance and supporting their professional identity.